For mild bleeding, consider NSAIDs if patient has no contraindications

Moderate/Failed NSAIDs

OCP: 1 pill TID x 7 days and finish pack

Progestin:

IM depot 150 mg and 3 days of 20 mg medroxyprogesterone

20 mg medroxyprogesterone TID x 7 days

Patient counseling

STD risk

Take the pill every day, same time

Breakthrough bleeding is still a risk

Side effects: weight gain

Management of unstable patient

ABCs, resuscitate

Per ACOG guidelines, 2-4 units O- PRBCs

Per ACOG guidelines, 6:4:1 ratio of PRBCs: platelets: FFP

However, this trial was retrospective and done in the OR

PROPPR trial:

1:1:1 trial in any patient with hemorrhagic shock

More applicable in the ED for shock associated with vaginal bleeding

25 mg IV estrogen q4-6h x24h

TXA 1 g IV over 10 min

PE and DVT side effects no more significant than placebo

Foley catheter, Bakri balloon, or Rusch balloon also option until definitive management available

Endometrial ablation

Uterine artery embolization

Hysterectomy

Journal Club: Beyond the Patient in Front of You, Public Health in the ED;

discussion led by Dr. Justin Yax (EM Attending)

Pertussis Vaccination in Adults- Dr. Sara Pope

Yorkgitis et al. Surgery, 2015

Web based national survey sent to trauma centers requesting information about tetanus vaccination and which version given to trauma patients (tetanus/diphtheria (Td) vs tetanus/diphtheria/acellular pertussis (Tdap))

61% completion rate of survey

Level 2 trauma centers had the highest rate of pertussis vaccination at 61%

Findings/Conclusions: There has been an increase in pertussis rates recently so giving the Tdap vaccine (as compared to the Td vaccine) can help significantly decrease the healthcare burden of this disease

Missed opportunities for HIV prophylaxis in the ED- Dr. Andrew Bloom

O’Donnell et al. Annals of Emergency Medicine, 2016

Retrospective database study used to determine what rate of occupational vs non-occupational patients that had a “blood or bodily fluid exposure” received HIV prophylaxis in the ED

Included patients from a single ED from 2007-2013

Findings/Conclusions: High risk non-occupational exposure patients were NOT given HIV prophylaxis at 2x rate of occupational exposure patients, with 1.9% of non-occupational exposure patients seroconverting at 6 months